Usa Ambulance Crashworthiness Frontal Impact Testing

Recent epidemiological studies have identified ambulances as high risk passenger transport vehicles, particularly the rear compartment. It appears in the absence of USA ambulance safety standards or guidelines, non engineer end-users are driving changes in practice and policy in place of independent peer reviewed biomechanical and crash injury outcome data. This study’s objective is to compare and analyze frontal crash biomechanical and crashworthiness research for ambulance vehicles, with a focus on application of the real world environment, and development needs for future standards. Frontal impact ambulance crashworthiness tests conducted over past 15 years, were identified and evaluated with a multidisciplinary approach consisting of automotive crashworthiness, emergency medicine, public health and EMS care delivery. Crash test data identified include: 25G to 34 G deceleration sled tests (delta V 20.9 to 32.3 mph); one full crash test of a bullet vehicle travelling at 36 mph crashing into another vehicle, impact Delta V of 30 km/h (18.5 mph) and deceleration of 14Gs to the rear compartment; and three fixed barrier frontal tests at a 40km/h (25 mph) delta V and 25 G impacts. There appeared to be a lack of correlation with real world crash forces in the conduct of the rigid barrier tests. The use of data from side facing occupants was also confounding. Ambulance crashworthiness is a complex system. Clearly demonstrated hazards have been identified in the limited real world crash injury/fatality data and the crash test data available. Testing must be based on meaningful real world parameters such as the forces that occur in actual crashes and the types of injury and fatality hazards to the occupants, so that development of standards and thus the design and construction of ambulance vehicles, can be focused to achieve adequate levels of occupant protection using current crashworthiness methodology already utilized in industry. INTRODUCTION There are some unique challenges to the crashworthiness, safety performance analysis and oversight of ambulance vehicles in the USA. Though there has been some very limited research focus on the crashworthiness and occupant protection performance of ambulance vehicles over the past 15 years, there has been no independent review and analysis of the limited work conducted to date. This vehicle safety realm is very much an interdisciplinary field, where the science of crashworthiness and occupant protection safety engineering interacts with acute medical care delivery, clinical ergonomics and also public health, public safety, transportation safety and safety data capture. EMS is a relatively new industry when compared with other emergency services such as police and fire, and it is an industry that has an unusual history of beginnings within the mortician industry in the USA. The first modern ambulances were hearses, usually a Cadillac, a vehicle in which an occupant could be transported in the recumbent position. In the 1960’s, just when general passenger vehicle safety and its occupant safety testing and oversight was rapidly advancing, ambulances transitioned into a box mounted on a truck or van chassis. Thus, largely due to end user and very much non automotive safety factors, ambulances moved away from general passenger vehicle safety oversight in the USA Additionally, the interior of the box, the rear passenger compartment also became distanced from any technical realms of ‘clinical ergonomics’. Reach and access to the patient and patient care equipment, also were without technical or scientific oversight or evidence base. The industry that took on this construction and retrofitting of the rear patient compartment box essentially was the recreational vehicle (RV) industry. That the construction, interior design and layout of the ambulance box in the 1960’s